Impact of Emergency Medicine Pharmacist on Door-to-Needle Tenecteplase Time for Acute Ischemic Stroke

Background: Emergency medicine pharmacist (EMP) involvement in stroke care has been associated with shorter door-to-needle (DTN) times of alteplase administration, which is crucial for optimizing outcomes in patients with acute ischemic stroke (AIS). Tenecteplase (TNK) is an alternative thrombolytic treatment, recently approved for AIS. The impact of EMP presence with use of TNK for AIS is unknown. Objective: To evaluate the effect of EMP presence on DTN times with TNK administration in patients with AIS. Methods: This single-center, retrospective cohort study evaluated adult patients who received TNK for AIS in the emergency department between January 1, 2023 and December 31, 2025. Patients were divided into 2 groups based on the presence or absence of an EMP. The primary outcome measured median DTN time. Results: Of the 154 included patients, 98 patients had an EMP involved in their stroke care. EMP presence was associated with a shorter median DTN time: 45 versus 56.5 minutes in the EMP absent group (P = .004). Emergency medicine pharmacist presence had faster median TNK preparation times (3 vs 9.5 minutes; P < .001) and faster administration times following preparation (4 vs 8 minutes; P < .001). National Institutes of Health Stroke Scale at 24 hours, intracranial hemorrhage, length of stay, and in-hospital mortality did not differ between groups. Conclusion: An EMP at the bedside of patients presenting with AIS resulted in reduced DTN time with TNK administration. These findings support the role of bedside pharmacists in stroke response teams to improve efficiency and achieve time-sensitive treatment goals.